Vascular Access Device Removal Flashcards

When removing a non-tunneled CVAD, how should the patient be positioned to reduce the risk of air embolism, if not contraindicated?

Answer: Supine or Trendelenburg

A supine or Trendelenburg position puts the insertion site below the level of the heart. This raises venous pressure at the site and lowers the chance that air will be drawn into the vein as the catheter comes out.

Which patient action as the CVAD is withdrawn best prevents air entering through the exit site?

Answer: Performing a Valsalva maneuver

The Valsalva maneuver raises intrathoracic pressure above atmospheric pressure, which keeps air from being sucked into the venous system as the last part of the catheter leaves the vein.

After removing a CVAD, which dressing should be applied to the site?

Answer: An air-occlusive dressing, such as petroleum-based ointment with a sealed dressing

The skin-to-vein tract can let air in after removal. An air-occlusive dressing seals the tract until it closes and should generally stay on for at least 24 hours.

The nurse meets resistance while removing a PICC. What is the most appropriate first action?

Answer: Stop, avoid forcing, and use measures such as a warm compress and waiting before trying again

Resistance is often caused by venospasm. Forcing the catheter can break it and cause catheter embolism. The nurse should stop, apply warmth, help the patient relax, wait, and try again gently. If resistance persists, escalate for imaging or provider evaluation.

Right after removing a CVAD, which assessment is essential to rule out catheter embolism?

Answer: Measuring the catheter length and inspecting the tip for integrity against the insertion record

Comparing the removed length with the documented insertion length, and checking that the tip is intact, confirms the whole catheter came out. A missing fragment needs immediate notification and imaging.

Which practice reflects evidence-based guidance on when to remove a CVAD?

Answer: Remove the device when it is no longer clinically needed or a complication requires it, not just because of how long it has been in

CVADs should not be replaced on a fixed schedule. Their need should be reviewed every day, and they should be removed promptly when no longer required or when a complication calls for it. Tip cultures are sent only when a catheter-related bloodstream infection is suspected.